Introduction:Obesity prevalence in Malaysian adults aged 18 and above has more than tripled over the past 20 years with 4.5% in 1996 to 17.7% in 2015. The alarming trend of the obesity epidemic in Malaysia requires im-mediate revision of public health policies. Thus this review was conducted to determine the effectiveness of latest weight reduction strategies. Methods: Literature search was conducted as guided by PICO Framework and using online databases PubMed on 22 June 2018. A total of 2,203 articles were found and screened. A total of 26 articles were reviewed. Results: Most weight loss achieved is through surgical intervention with weight reduction of 20.8 kg compared to 8.5 kg reduction in control group (95% CI, p < 0.001). Non-invasive procedures that produced greatest weight reduction include diet modification strategy consisting of isocaloric diet with large breakfast (700 kcal) which produced weight reduction of 8.7 ± 1.4 kg compared to large dinner (700 kcal) 3.6 ± 1.5 kg (95% CI, p < 0.0001, and special diet of adding 3g/day cumin supplementation into normal diet which produced weight reduction of 6.2 kg compared to 4.19 kg reduction in control group (95% CI, p < 0.05. Conclusion: In this review, most weight loss is achieved through surgical intervention. All patients should receive lifestyle therapy and additional consideration should be given for pharmacotherapy and bariatric surgery when indicated.
Introduction: Illegal immigrants refer to the migration of people into a country in ways that violates its immigra-tion laws. A stateless person is a person who is not considered as a national by any state under the operation of its law. Interestingly, many who are stateless have never even crossed an international border. The term illegal is very loosely used in places like Sabah where it is interchanged with statelessness. As of 13 November 2018, it was estimated that there are about 12 million stateless people in the world. This review seeks to understand the current demographic situation in Sabah along with the public health repercussions of this demographic change and also to look into the success stories from around the world along with the recommendations from United Nation in solving this matter. Methods: The method used is reviewing of literature of previous studies conducted on statelessness and illegals. Local as well as international studies were reviewed. The data base used was ProQuest. Results: This review identified that one third of Sabah’s population consists of non-locals and in the past 27 years, about half a million illegal immigrants have been deported from Sabah. These numbers pose major public health repercussions from the economic, crime and health point of view. The way forward involves incorporating the United Nation Action plan with the local requirements and settings. Despite challenges, Sabah is trying its best to curb this issue and the Public health repercussions through various initiatives. We have also identified that more public health actions can be taken to reduce the negative effects. Conclusion: Dealing with the stateless and illegals is a delicate matter and there is no one way to solve it. Every country and every state are unique therefore the methods used must be tailor made. This is not something that can be solved within a short period of time and therefore persistence and perseverance is very much needed to tackle this global issue.
Introduction: Despite considerable effort invested for tuberculosis (TB) control, the outcome has not been optimal due to several barriers. Stigma has been an important factor that hinders the completion of full course of TB treat-ment, i.e. it results in poor treatment adherence. This systematic review is aimed to review the interventions target-ing tuberculosis related stigma in order to improve treatment adherence among tuberculosis patients in developing countries. Methods: A systematic electronic database search (PubMed, Google Scholar, ProQuest, Science Direct, Ovid, Spring and Cochrane) covering articles published between 2008 and 2019 had been conducted using truncat-ed search words of “stigma related to tuberculosis”, “TB Stigma”, “Intervention”, “treatment adherence”, “treatment compliance”, and “developing countries”. Only English articles exploring stigma among TB patients and its anti-stig-ma intervention in developing countries were included. Results: A total of 846 articles were retrieved and 346 were excluded due to duplication while another 361 non-relevant articles at the stage of title screening were excluded. Subsequently, 119 articles were excluded for not fulfilling inclusion criteria and only 3 studies remained. Conclu-sion: From the three articles, TB treatment outcomes were improved with the use of stigma intervention, including health education and counselling, self-support, and psychological support interventions. Optimal implementation of stigma interventions may vary by setting, resources, and the local TB epidemiology. More controlled interventional research is needed in stigma reduction that leads to improve TB adherence in developing countries.
Introduction: Chemical pesticide is commonly used among vegetable family farmers in Sabah. There is no system to monitor adverse health effects. This study is to determine the blood cholinesterase activity and associated factors among vegetable family farmers. Methods: A cross sectional study has involved 163 farmers aged 18-60 years old. Validated questionnaire was used to assess the associated factors. Lovibond AF267 Cholinesterase Kit was used to determine the blood cholinesterase activity. Chi square test was used to determine the association between blood cholinesterase activity and socio demographic factors and work practices. Results: Approximately 23.3% of study sample had low blood cholinesterase activity. There were significant associations between low blood cholinesterase activity with older age group (p
Nurses’ job performance is defined as the effectiveness of a person in carrying out his or her duties related to patient care. Aim of this study is to measure job performance among nurses in a tertiary hospital and its associated factors. A cross-sectional study was conducted among nurses selected from four departments, which were Obstetrics & Gynecology (O&G), medical, surgical and Cardiac Care Unit (CCU)/High Dependency Unit (HDU). A Malay validated Six-Dimension Scale of Nursing Performance (6-DSNP) questionnaire was used to measure job performance. Nurses who have one child more compared to other nurses had significantly lower total mean score of job performance by -0.06 (95% CI 0.11, 0.01). Nurses working in medical department [adj.β=0.16 (95% CI 0.01, 0.30)] and CCU/HDU [adj.β= 0.33(95% CI: 0.17, 0.50)] had significantly higher total mean scores of jobs performance compared to O&G department. Effective strategies and re-examining work conditions are imperative for better job performance.
Study site: Department of
Medical, Department of Surgical, Department of
Obstetrics & Gynecology (O&G) and Cardiac Care
Unit/ High Dependency Unit (CCU/HDU) of Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM)
Introduction: One of the biggest global health threats of the 21st century is climate change It is so catastrophic that the climate action has been given a platform as it is the 13th goal of the 17 United Nations Sustainable developmen-tal goals (SDG). This review seeks to understand the factors causing climate change, followed by understanding the impact it has on individual and population health. We also identify the strategies to control and prevent further cli-mate change. Methods: Reviews of local and international articles from the past ten years was conducted. The focus of the review was the causes, health effects as well as strategies. Data base used was Pro Quest. Results: This re-view identified that the main contributor to climate change are man-made activities such as fossil fuels combustion, livestock farming, and deforestation. This change in climate has many repercussions from mass migrations, increase communicable diseases as well as an increase in extreme weather events and natural disasters. All this eventually leads to the deterioration of individual and population health. Strengthening adaptivity to climate-related hazard, climate change integration into national policies, education, awareness-raising, impact reduction and early warning are actions that are present in Malaysia to manage this crisis. Conclusion: Climate change is occurring globally, and its presence can no longer be denied. Actions have been put forth, but only when its importance and impact is taken seriously will the positive changes be sustainable.
Introduction: Cholera epidemics can produce devastating public health outcomes. Cholera distribution is influenced by temperature, precipitation, elevation, distance to the coastline and oceanic environmental factors such as sea surface temperature, sea surface height and ocean chlorophyll concentration. The purpose of this study is to describe the spatial epidemiology of cholera in the four districts of Sabah. Methods: This is a retrospective review of 4 years (2011 to 2014) data from the districts of Kota Kinabalu, Penampang, Putatan and Papar, Sabah. All reported cases of cholera from those areas are included. Coordinates for locations of the cases are based on home addresses. SPSS v20, ArcGIS v10 and CrimeStat IV were used for data analysis and mapping. Results: Cholera showed several clustering of cases, such as in 2011 and 2014 in Kota Kinabalu. In the year 2011 and 2013, Penampang and Papar districts had the nearest neighbour index of less than 1, but p value was not significant, meaning the pattern did not appear to be significant. Nearest neighbour hierarchical clustering analysis further revealed cholera had 7 clusters, of those 6 were first order and 1 was a second order cluster. Conclusion: Cholera shows disease clustering which could mean it is due to its common point source or localised human to human transmission. Using GIS as a tool may help in surveillance and control of cholera infections.
Introduction: The objective of this presentation is to carry out a review of the historical status and possible future outlook of the practice of ethnomedicine in the State of Sabah. As in many parts of the world, there are many types of traditional medicines that have been used for hundreds of years among the various native cultural groups in Sabah. Methods: A literature survey was conducted with the aid of online database, and text books using keywords such as the current as well as previous names of Sabah and various related terminology such as ethnomedicine, CAM, complementary and alternative medicine, TCM, traditional and complementary medicine, herbalism, reflexology, spiritualism, ethnobiology ethnology, ethnoanthropology, biological activities, ethnobotanical uses, medicinal prop-erties, toxicity studies, etc. The status of ethnomedicine in Sabah is largely unknown. Results: Based on a review of previous literature, the study discovered that there is limited empirical documentation on the use of ethnomedicine in Sabah. In this preliminary review, a total number of 25 publications were recorded in the databases for the period up to 2019. There is still a need to realise the full potential of the biocultural diversity of Sabah, and that there is a strong need to focus more on socially relevant research. Ethnomedicine in Sabah consists mainly of herbalism, ma-nipulative practices and spiritualism. Plants can be said to be the central player in race-based traditional medicine. While data on ethnomedicine may be based on original field research, several are primarily derivative, drawing as they do from earlier published accounts and, importantly, anecdotes. Traditional massage and other manipula-tive-practices, based on manipulation and movement of body parts, are also popular because of their simplicity and apparent immediate relief that can be experienced by the patient or client. Spiritualism, which may be considered as a peculiar dimension of the mind-body medicine subset of traditional medicine, continues to have its adherents among the natives of Sabah. Conclusion: List and catalogs and sociological and ethnohistorical data were the fa-voured perspective of research in the past; but future evolution of ethnomedical studies need to address some of the debates related to biological, medical and social sciences . Future research should include systematic inves-tigation into efficacy and risk besides the possible incorporation of some parts of ethnomedicine into the existing healthcare services. Ethnomedicine occupies a distinct place in healthcare in the world in general, and Sabah in particular.
Introduction: Hypertension prevalence is increasing globally and has become a major issue of disease as it is a major cause for cerebrovascular, kidney and cardiovascular diseases. Even among treated patients, there is a dispropor-tional of blood pressure control causing a major public health challenge. This study is aimed to decide on the prev-alence of uncontrolled hypertension and its associated factors among hypertensive patient attending hypertension clinic at primary health clinics in Tuaran district. This study is justified by the fact that uncontrolled hypertension leads to high mortality, morbidity and even premature death. Methods: This study is a cross-sectional study among 460 hypertensive patients attending three primary health clinics in Tuaran district, Sabah. Data were collected using structured modified questionnaires through interviews, physical examinations and patient’s medical records. Types of data collected include socio-demography, lifestyle behavior, physical examination, co-morbidity status and med-ical adherence. Data analysis done using SPSS version 24.0. Results: Prevalence of uncontrolled hypertension was 45.9%. The study found that factors significantly associated with uncontrolled hypertension with p
Introduction:Diabetes is high in the agenda of public health issues with significant prevalence of diabetic-related amputations. Prosthetic restoration post-amputation is imperative to reduce disability, but its success is influenced by several factors. This study analysed the practice, and the determining factors affecting prosthetic restoration among major lower limb amputees with diabetes in Sabah. Methods: Retrospective cross-sectional study among 65 major lower limb amputees with diabetes referred for rehabilitation medicine services at Queen Elizabeth Hospital from 1st January 2015 to 31st December 2017. Demographics data, pre-morbid diseases, levels of amputation and prac-tice on prosthetic restoration (suitability for restoration, duration from prosthetic application to restoration, funding issue) are primary evaluated factors. Results: Forty-nine, fifteen and one amputees had below knee amputation, above knee amputation and hip disarticulation respectively. Forty-three amputees (66.2%) were deemed suitable for prosthetic restoration but only 27 were prosthetically restored, with mean duration from prosthetic application to res-toration of 5.92±2.189 months. Having additional pre-morbid diseases did not reduced the likelihood of suitability for prosthetic restoration compared to those only with diabetes (p=0.082). Funding issue is the key factor affecting prosthetic restoration with higher likelihood for restoration among those eligible through governmental agencies funding (p=0.027). Conclusion: In Sabah, low rate of suitability for prosthetic restoration is observed among major lower limb amputees with diabetes. A larger study is warranted to investigate causes of such low rate of suitability for prosthetic restoration among this specific population in the effort to reduce public health burden from major lower limb amputation-related disability.
Introduction: Melioidosis, also known as Whitmore disease, is caused by the gram-negative bacillus, Burkholderia pseudomallei and remains a public health concern in Southeast Asia and northern parts of Australia. This study attempts to identify all possible complications of melioidosis and its outcomes.
Methods: Literature search was conducted from databases such as PubMed, Science Direct and Scopus from 1st January 2000 to 31st August 2019. Medical Subject Headings (MeSH) search strategy was used with the terms ‘Melioidosis’ or ‘Burkholderia pseudomallei’ and ‘Complications’.
Results: A total of 162 titles were identified and 22 articles were included in the review. Findings showed that among the 22 articles, the ratio of male to female melioidosis incidence was 2.3 to 1, with most cases (86.4%) aged older than 14 years old and showed a mean age of 46 years old. A third (7/22) of the papers reported the involvement of the nervous system as a complication of melioidosis followed by cardiovascular complications. Among the 23 cases reported, 13 had underlying medical conditions with most of them (84.6%) having diabetes mellitus or newly diagnosed with diabetes mellitus. Overall, only one case (4.3%) had resulted in mortality, while 17.4% developed complications and 78.3% managed a full recovery after undergoing treatment for melioidosis.
Conclusion: The most commonly found complication of melioidosis involved the nervous system but patient outcomes were favourable. Rare complications included mycotic aneurysm that can be fatal. Melioidosis can affect almost any organ leading to various complications.
This article will cover some of the most recent advances in the diagnosis of the world’s most common cancer in women, namely, breast cancer as we enter the era of precision medicine. The authors will discuss the differences between East and West pertaining to the incidence and mortality rates, the types of breast cancer and the revised staging criteria of breast cancer according to the American Joint Committee on Cancer (AJCC) Staging Manual, 8th edition. In addition, the advances of newer imaging modalities are presented and compared with traditional ultrasonography and mammography